Showing papers by "Manfred S. Green published in 1998"

Influenza Vaccine Efficacy in Young, Healthy Adults

Abstract: Findings concerning influenza vaccine efficacy in young, healthy adults are inconsistent. A high incidence of influenza in the winter of 1995 provided an opportunity to study the efficacy of influenza vaccine among young, healthy military personnel. Influenza activity was confirmed by isolation of influenza A and B viruses from nasopharyngeal swab specimens from hospitalized soldiers. Self-administered questionnaires concerning vaccination status and disease symptoms were used in two study groups: recruits and veteran soldiers serving in different camps. Six hundred eighty-four individuals had received influenza vaccine and 652 had not. Vaccine efficacy was found to be 38.1% (P = .002) for preventing febrile illness with or without symptoms and slightly higher (41.6%; P < .001) for preventing fever together with upper respiratory tract symptoms. The current influenza vaccine significantly reduced febrile illness among healthy military personnel.

Factors associated with inappropriate hospitalization days in internal medicine wards in Israel: a cross-national survey

Abstract: Background. The high costs of health care mandate a quality control system that ensures efficient utilization of hospitalization days. Objectives. To obtain a national estimate of the rate of inappropriate hospitalization days in medical wards and to identify the variables associated with inappropriateness. Design. A 1-day cross-national survey. Setting. A sample of internal medicine wards in all public hospitals in Israel. Survey population. The survey population included all patients hospitalized in the ward for at least 24 hours on the survey day. Instruments. We used an adapted version of the appropriateness evaluation protocol (AEP) (Gertman and Restuccia). Reviewers were final year medical students trained to work with the AEP. Final classification of inappropriate days was done by one of the senior investigators. Outcome measure. Utilization of hospitalization days according to the AEP. Results. A total of 1003 hospitalization days in 33 medical wards in 24 hospitals was surveyed. Of this, 182 (18.1%) of the days were found to be inappropriate. In multiple logistic regression analysis, variables significantly associated with inappropriate days were government versus other hospital ownership (OR, 1.51; CI, 1.15—1.96), diagnosis on admission of acute cardiac event versus other diagnosis (OR, 0.46; CI, 0.27—0.77), and period (first, second or final third) of the stay (OR, 1.61; CI, 1.29-2.03). In 62.6% of the 'inappropriate days', continuation of hospitalization was justified (72% were patients awaiting tests or consultation). In 6.7% of the total days surveyed, no justification for continuation of hospitalization was found. Conclusion. The percentage of inappropriate days found in this study is similar to the means found in studies that were conducted in other countries. Awaiting procedures and consultation is a major cause of inappropriate days and may be an important target for intervention.

Differences between Israeli Jews and Arabs in morbidity and mortality rates for diseases potentially associated with dietary risk factors.

Abstract: Background Cancer, ischemic heart disease, cerebrovascular disease and diabetes together comprise almost 70% of the causes of death in Israel. Dietary factors such as total caloric intake, saturated fats, polyunsaturated fatty acids, trace elements, vitamins, certain proteins, and fiber have all been suggested as playing a role in the pathogenesis of these diseases. Aim In this study, patterns of mortality and morbidity (where available) for selected diseases were compared between the Jewish and Arab population groups in Israel. Methods Data on cause-specific mortality in Israel between 1973 and 1994 were obtained from the Israel Central Bureau of Statistics. Age-adjusted rates for selected diseases were compared between the Jewish and Arab population groups. Results Until 1987, the age-adjusted ischemic heart disease mortality rates in the Arab population were slightly lower than those in the Jewish population. Since 1990, they have been slightly higher. Cerebrovascular disease mortality rates have consistently been higher in the Arab population and the gap has been increasing. Similarly, the mortality rates for diabetes mellitus were slightly higher in the Arab population during the 1970 and 1980s and the gap has increased markedly. On the other hand, age-adjusted mortality rates from colorectal cancer are about three times as high and breast cancer mortality rates about twice as high in the Jewish population. The differences for incidence rates are even greater. Conclusions This study demonstrates the contradictory mortality rates for cardiovascular disease as compared with colon and breast cancer in the Jewish and Arab population. While representative dietary data for the populations are lacking, there is evidence that the dietary patterns of the Jewish and Arab population groups differ in many important aspects. It is possible that this may at least partly explain the contradictory differences in mortality and morbidity. The national nutrition surveys currently being initiated by the Ministry of Health should contribute to a better understanding of this subject.

Immune status against diphtheria among immigrants from the former USSR who arrived in Israel during 1990–1991

Abstract: Large outbreaks of diphtheria occurred recently in the former USSR. Between 1989 and 1994, a total of about 600,000 Soviet immigrants arrived in Israel. The immune status against diphtheria in a sample of 992 men aged 17-49 and 195 women aged 17-19, who arrived in Israel during 1990-91, was studied in order to evaluate the need for vaccination. Participants completed a self-administered questionnaire and diphtheria antitoxin antibody levels were measured by means of ELISA. At age 17-19, the prevalence of antitoxin antibody levels below the protective level of 0.01 IU/ml was 4.8% in the men and 2.1% in the women. Among the men, the percentage lacking protection declined from 4.8% at age 17-19 years to 1.6% at age 20-24, and increased to 18.2% at age 35-49. In the oldest group, the prevalence of those lacking protection was considerably higher than for the general Israeli population. In the multivariate analysis, age, mother's education and republic of origin were significantly associated with the absence of protection. Immigrants from the former USSR appear to be more susceptible to diphtheria, thus increasing the possibility of clinical disease, and it is recommended that they receive booster doses of diphtheria toxoid.